Background Neighborhood Health Service Corporation (NHSC), an urban community-based not-for-profit ambulatory health centre located in Plainfield, New Jersey, USA, provides prenatal services, labour and delivery to 750 uninsured, impoverished, minority women annually. Given that New Jersey has the third highest number of HIV women in the USA and the highest number of HIV positive children, early HIV detection and intervention in pregnant women become paramount. NHSC historically struggled with sub-optimal HIV testing rates (60%) in the pregnant patient population and needed to make radical programme changes to comply with CDC recommendations to ensure HIV testing is offered to 100% pregnant patients.
Methods A PDSA (Plan-Do-Study-Act) cycle was conducted to test a new, patient-centred HIV testing approach: HIV Counselors are located in OB department; HIV counselling and on-the-spot Rapid testing are done at the time of initial OB registration; daily registration schedules are available to HIV Counselors at the beginning of workday; HIV results become part of OB records immediately upon result availability; educational DVDs are utilised in patient areas to increase awareness/interest among pregnant patients and their partners.
Results Per the revised and PDSA-improved strategy, NHSC achieved and sustained a 100% compliance with CDC OB HIV testing recommendations over the past four years. Rapid HIV testing and Rapid-on-Rapid positive result confirmation allow for smooth and timely transition from HIV testing to the on-site HIV Early Intervention Services (EIS) for newly diagnosed HIV pregnant patients and their partners.
Conclusions The collected and analysed data suggests that convenient, coordinated, patient-centred approach to HIV counselling and testing among pregnant patients helps to: identify HIV positive pregnant patients early-on, preferably in the first/second trimesters; immediately connect them to prenatal and HIV care and treatment services to minimise vertical HIV transmission; provide prevention services, HIV testing and treatment options for partners including prevention for positives.
- HIV testing
- partner services